2017-03-28_REPORT - M1983067

• Permit No: M1983067
• IBM Index Class Name: Report
• Doc Date: 3/28/2017
• Doc Name: Annual Fee/Report/Map
• From: Albert Frei & Sons Inc.
• To: DRMS
• Email Name: JLE
• Media Type: D
• Archive: No

Pagc 5 of 5
Division records indicate the following pennittee/landowner contact information (blank fields indicate that we do not have
information on record). If this information is blank or not current, please type or print current contact information:
Permittee Contact: Ben Frei
Permittee Company: Albert Frei & Sons Inc.
Address: P.O. Box 700
Henderson, CO 80640-0700
Phone Number: [phone]
Fax Number:
Email Address: Bfreigalbertfreiandsons.com
Permitting Contact: Ben Frei
Company: Albers Frei & Sons, Inc.
Address: P.O. Box 700
Henderson, CO 80640
Phone Number: [phone]
Fax Number:
Email Address:
Inspection Contact: Ben Frei
Company: Albert Frei & Sons, Inc.
Address: P.O. Box 700
Henderson, CO 80640
Phone Number: [phone]
Fax Number:
Email Address:
I, the undersigned, hereby state that the information provided in this report is true and accurate, and that site'loperations are
being conducted in accordance with the Division approved mining and reclamation plans.
I,V � 4�' I?
Sig ature of Permittee, Corporate Officer,O er,or Documented Designee Date